Induced vivax malaria recently was proposed for the treatment of neuroborreliosis (7). The precedent for this approach is the obsolete practice of malariotherapy for the treatment of neurosyphilis, which was widely used in the preantibiotic era (8). Controlled studies of malariotherapy for neurosyphilis never were done; published results suggested that the response to treatment was unpredictable and primarily clinical and that the duration of remission was variable (9). Changes in serologic status generally did not correlate with clinical improvement, suggesting that malariotherapy had minimal, if any, effect on the underlying spirochetal infection (9). Malariotherapy for syphilis was discontinued when penicillin and other effective antibiotics became available.

For at least three reasons, induced malaria is not recommended for the treatment of Lyme disease. First, no scientific studies exist of the efficacy of this procedure for the treatment of this disease. Second, malariotherapy causes iatrogenic morbidity and carries a direct risk for death from complications of P. vivax infection (8) or from coinfection with other, undetected, bloodborne pathogens. Third, a small but finite risk exists of local transmission of malaria when parasitemic persons enter the United States (10). Iatrogenic malaria cases should be reported promptly to local and state public health agencies.

Media Coverage

A Living Death: Lyme DiseaseLinda Braden Albert, The Daily Times, 2002-04-30
URL: http://www.thedailytimes.com/sited/story/html/90778(this article describes the experiences of Donna Finley Blair of Maryville, TN; Ms. Blair reportedly received malariotherapy for Lyme disease in a clinical trial conducted in Mexico in the early 1990s)

Yet more troubling is malaria therapy for chronic Lyme disease. Some entrepreneurs, among them a few physicians, take groups of Lymeys to Mexico or Panama for injections of human blood containing malaria parasites. The basis for this practice as a treatment for Lyme disease was a thought-provoking but speculative letter to the editor of the New England Journal of Medicine, published on April 26, 1990. It was written by Henry J. Heimlich, a physician best known for the anti choking maneuver that bears his name. Dr. Heimlich pointed out that many features of chronic Lyme disease resemble those of late-stage syphilis, an illness caused by a spirochete distantly related to the Lyme organism. As he observed, infection with malaria (made temporary by subsequent anti malaria medication) was used from 1917 to 1975 to treat resistant cases of syphilis affecting the nervous system. He speculated that the same approach might relieve chronic neurological symptoms in patients with Lyme disease. A year later, Dr. Heimlich also made the case for malaria therapy in Lyme Disease Update, a newsletter based in Mill Shoals, Illinois.

Did malaria therapy work for syphilis? Dr. Heimlich writes that tens of thousands of patients with neurosyphilis were cured and adds that the treatment is still recommended for chronic syphilis affecting the nervous system when repeated courses of antibiotics have failed. But the Centers for Disease Control has issued a statement that the effectiveness of malaria therapy for neurosyphilis was variable and unpredictable. Therapeutic trials were not carried out following strict scientific guidelines, and thus the effect of treatment cannot be adequately evaluated. The CDC also terms malaria therapy obsolete for neurosyphilis.

Exposure to human blood is required to transmit the malaria parasite — an ironic twist in an era when people store their own blood prior to surgery, rather than run the risk of contracting AIDS or hepatitis from even rigorously tested donor blood. According to David T. Dennis, coordinator of the Centers for Disease Control's research program on Lyme disease in Fort Collins, Colorado, We just don't know how carefully the blood used for malaria therapy outside the United States is screened.

Desperate patients are willing to pay dearly for special trips to places where malaria therapy is legal. For example, at a center in Panama, Lymeys can be injected with malaria-containing blood for $10,000. In addition, the patients must pay for transportation, meals, and hotel accommodations for up to 30 days during the period of treatment.

Two of the first American patients injected with malaria-containing blood at a Mexican clinic still harbored malaria parasites when they returned to New Jersey. One of them has since repudiated the treatment, saying that she is just as sick now as she was before she went to Mexico. Last year, an official CDC statement on malaria therapy emphasized that there is no proof that the treatment is safe or effective for Lyme disease, and it warned that severe illness and death might result from either runaway malaria or another blood-borne illness, such as hepatitis B or AIDS.